Persuasion

In the course of my career as a cardiologist, pitching a plant-based diet to patients has become easier over time.

It's easier now that plant-based diets are more mainstream.  From movies like Forks Over Knives, What the Health, or Cowspiracy, people are learning about the health benefits of plant based eating.  And, as there are more vegans, there are then more vegan options in grocery stores and restaurants, making a plant-based diet seem more attainable.

But I think that over time I've also become a better, more comfortable advocate for plant-based eating.

The most effective time to make the pitch for plant-based eating is at the hospital, at the time of a health crisis like a heart attack.  After all, diet is a major reason why people have heart attacks.

Sometimes the conversation actually happens while the patient is on the cardiac cath lab table, having just received a coronary stent.  Other times it may happen in the patient's room the next day, or maybe in the office on the first follow-up visit.  We talk about his or her current diet, what might be good in it, and what might not be so good.  Next, I explain, "The best diet for the heart is a plant-based diet, as it has been demonstrated to reverse plaque in the arteries.  Would you like to try that type of eating here in the hospital?"  I'll also recommend watching Forks Over Knives, if the patient and his or her family has access to a mobile device at the hospital.

I've found great success with this approach.  With one patient, I came back to his room to find a copy of Michael Greger's How Not To Die on his bedside table, thanks to enthusiastic family members.  Many patients even convince their entire immediate family to start eating plant-based as well.

I have a large number of plant-based patients, some who sought me out because I am a vegan cardiologist, and others whom I've convinced of the benefits of plant-based eating.  And I stand by this statement -- in over 11 years of practice as a cardiologist, not a single plant-based patient under my care has gone on to have another heart attack, need another stent, or need a bypass surgery.

That Time I Stented A Vegan

A whole food, plant-based diet will help you live longer and reduce your risk of heart disease, heart attack, stroke, diabetes, and perhaps some types of cancers.

However, it's not a magic bullet -- just because you eat a vegan diet, this does not mean you are immune from all health ailments.

A couple of years ago, I was consulted on a man in his early 50's with chest pain.  He was concerned enough about the pain to come to the emergency room, but upon talking to me, he was trying to play it off.  "Oh, it's not that bad, I have reflux, I'm okay now."  

He's a vegan, he tells me, after watching Forks Over Knives a couple years ago.  He eats a fair amount of restaurant food and certainly likes french fries.  And at that time, I'd classify his body size as modestly overweight.

I wanted to be able to tell him that his heart was fine, but there were a few things that just didn't sit right -- his EKG had some abnormalities that suggested ischemia, or a lack of blood flow to part of his heart.  He had risk factors as well, a family history of heart disease, abnormal cholesterol levels particularly with a low HDL, and high blood pressure.

I ordered an echocardiogram, which is an ultrasound of his heart.  I had the chance to look at it immediately after it was done.  It was quite abnormal.  The front wall of his heart was not moving at all, suggesting an acute plaque that could be sitting in the left anterior descending.  

I showed the echocardiogram images to my vegan patient.  He looked on, stunned, as I explained that his chest pain was probably unstable angina.  We planned a coronary angiogram for the following day.

The angiogram demonstrated a severe narrowing of the left anterior descending coronary artery, which is the artery that runs down the front wall of the heart.  I placed a stent to open the artery.  As he was suffering from unstable angina, this is a situation in which placing a stent does save lives.

This is what a severe narrowing of the left-anterior descending looks like

He's doing great now.  He's adopted an Esselstyn-style whole-food plant-based vegan diet.  He's lost a significant amount of weight.  He also exercises regularly.  As a result, he's been able to come off his blood pressure medications.  At present, his only medicines are a baby aspirin and a statin.

So what happened, why did a vegan have an unstable angina event?  He had risk factors for heart disease, which included a family history, high blood pressure and abnormal cholesterol.  Also, while he was a vegan at the time of his event, he had spent most of his life on a standard American diet, and his vegan diet probably wasn't the healthiest.  Remember, Oreos, potato chips, Twizzlers, and Pepsi are all vegan, but they're certainly not health foods.

I believe that with continuing a whole-food plant-based diet and regular exercise that his heart will remain healthy for years to come.

On Private Practice

I'm now more than 6 months into this adventure of private practice.  It's been a lot of hard work, but well worth it.

The toughest part -- learning the business of medicine.  As an employee first of one local practice, and then as an employee of Lakeside for nine years, I saw patients, did procedures, and submitted the codes for my work, and that was it.  I never had to worry about insurers and contracts.  I had no idea of the difference between fee-for-service and capitation, and certainly not a clue of what an EOB (explanation of benefits) is.

There's also running a business.  Medical school, residency, and fellowship don't teach business.  I had good advice from people who know more than I do about business.  My sister-in-law Mary Ruth helped to put together documents to set up the corporation.  Laurence Kinzler of MGMA helped start me on the process, from my rough ideas of what I wanted to do, to a specific timeline of opening the practice.  Jill Freiberg helped me with my insurance contracts and with plenty of advice from her years of experience.  And conversations with a few local cardiologists were quite helpful as well.

One of my exam rooms

The office opened on January 2.  Things were slow initially, which allowed enough time to fine-tune our operations, and for us to learn how to use our new electronic medical record.  Business gradually has picked up.  By the end of February, money started to come in, at the end of March the practice was breaking even, and thereafter the practice is definitely thriving financially.

I've set up a practice to provide a more personal experience.  We're a small office, so if you call during business hours we pick up the phone, you don't get a recording.  If you feel you need an appointment ASAP, we can make that happen, there's no waiting for weeks to see the doctor.

My waiting room

I have no regrets, other than I wished I'd ventured out on my own sooner.

If you're a former patient, give us a call and see if we take your insurance, we probably do.  If you need a cardiologist, or know someone who needs a cardiologist, call us at 818-938-9505.

New Research on Eggs -- Beware the Details

Eggs are in the news again.

A recent study from the American Journal of Clinical Nutrition comes to the conclusion that there is no risk from eating up to twelve eggs a week.  Look closer.  There are some important details --
-- The study was paid for by the Australian Egg Corporation.
-- The "low egg" group ate two eggs per week, BUT ate more meat to make up for eating fewer eggs.

Another recent study has led to headlines like, "An egg a day to keep the doctor away"  The article, "Associations of egg consumption with cardiovascular disease in a cohort study of 0.5 millon Chinese adults," was featured in BMJ Heart.  Issues with this study:
-- This was an observational study. You can't make definitive cause and effect conclusions from observational studies.
-- People in China who consume more eggs tend to be more affluent
-- The study relied solely on dietary recall, a questionnaire asking people what they eat, not observing what they eat.

I'm not about to start recommending eggs to my patients.  Eggs do contain a large amount of cholesterol, and while dietary cholesterol is not the sole cause of high cholesterol in humans, it definitely contributes.  Eggs also have choline which increases the risk of developing and dying from several kinds of cancers.  PCRM's The Exam Room Podcast from last week does a great job of tackling the subject of eggs and health.

Some people may suggest that the egg itself isn't the problem, but rather the foods that often accompany eggs -- ham, bacon, sausage, butter, and cheese, for example.

There are so many healthier foods to enjoy for breakfast.  Oatmeal is my favorite easy go-to breakfast, but if you want something hearty with the consistency of eggs, a tofu scramble is a filling and healthier choice.  One of my first blog posts twelve years ago featured a tofu scramble, or you can check out my book on Amazon for a great tofu scramble recipe, along with many other recipes.

Heart U -- Weight Loss, featuring Lori Manby

As part of my mission to educate and empower my patients, I am holding monthly Heart-U educational sessions.  This month's session, coming  up on Monday, April 23 at 6:30 pm in my office will feature the topic of weight loss.

I've had countless discussions with my patients about weight loss.  Losing weight, and then maintaining a healthy weight for the long term, is a goal that eludes many.

Lori Manby has succeeded.  She lost 80 lbs and had maintained that weight loss.  She uses the Weight Watchers program to guide her food choices. She has used her experience to pay it forward by founding the support group Vegans of Weight Watchers.

Her story is compelling.  And if you're struggling with weight loss, she's the perfect person for your to hear from.

Please attend her talk this coming Monday, April 23.  You can RSVP here, or call my office at 818-938-9505.

Read more about Lori here in Weight Watchers' online magazine

The ones we don't save

One of the most rewarding parts of my job is saving lives.  I can open a blocked coronary artery in the setting of a heart attack.  Or I can help prevent that heart attack by guiding my patients to good lifestyle choices, and when necessary, prescribing medication.

Everyone knows I'm passionate about lifestyle and the power of food and movement.  I will admit, though, as an interventional cardiologist, I enjoy procedures, and I take call at a few local hospitals to care for those in the throes of a major heart attack.

Far more often than not, my team and I work together, open an artery, and save a life.  The gracious patient who no longer has chest pain thanks me and my team, and goes home in a day or two.

It's the patients who don't have that outcome that haunt me, especially when they are young.  I was called emergently for a man in his 30's.  When I arrived, he was sweating profusely, clearly in pain.  His blood pressure was low, so I knew we needed to start working immediately.

I got some brief information from him -- he'd had pain for several days.  He smoked.  He had a strong family history of heart disease.  He hadn't been to a doctor in a long time.

I had one of the best scrub techs at my side, as we worked hard first to get access into his artery and vein.  I worked as quickly as I could, advanced a catheter to his left main, injected it to see that the left anterior descending, the widow-maker artery, was completely blocked at its origin.

His blood pressure was dropping, and we gave medication to support that blood pressure.  I knew I needed to open that artery.  I managed to get a wire into that artery, inflate balloons within the artery, saw blood start to trickle through.  But there was so much clot that had organized in that artery.

Then his heart stopped.  We did cpr, we shocked him, we provided every intervention at our disposal that we could to save his life.

He didn't survive.

I think about this patient often.  I remember telling his wife who sobbed, absolutely shocked and devastated.

I also think, this didn't need to happen.  What if he had come in a few days earlier when his pain started?  What if he hadn't smoked?  What if he had been to a doctor, who may have been able to treat high blood pressure or high cholesterol?  What if someone had gotten through to him to convince him to eat better, to exercise?

I think about what I could have done differently as well.  He was so sick on arrival, I just don't know that I could have done anything differently that would have saved him.

What's my point?  Heart disease can be deadly.  Even if you have no symptoms, but you have risks -- high blood pressure, cholesterol, family history -- manage those risk factors.  Eat right, exercise, if you have high blood pressure get it under control, if you have diabetes, get it under control.  Quit smoking if you're a smoker.  See your doctor and listen to your doctor.

On Starting a New Practice

I opened my new practice three weeks ago.  After ten and a half years as an employed cardiologist,  I'm now an employer.  A solo physician.  A business owner.

In medical school, residency and fellowship training, I never thought I'd work on my own.  I learned the science of medicine and cardiology.  I paid little attention to the business of medicine, up until a bit less than a year ago, when the gears in in my head started turning.  Before that, I never thought that I would go it on my own.  I brushed off any suggestion of being independent -- the expenses are so high.  It's so hard to fight for patients, and would my established patients even come with me?  And all the work of starting and maintaining a practice -- is it worth it?

Room 4.  Of course that's a greyhound on the wall!

As I thought more, the potential of independence appealed more and more to me.  The ability to practice in my own setting, in the way that I want, during the hours that I want, without approval from management.  The independence to run a cardiology practice in a way that suits my philosophy of health.

Starting a medical practice is tough.  I have an incredible respect for anyone who runs his or her own medical practice, or any business for that matter.  But, I've found that even if the hours are long, it's work for a purpose -- to build something that is mine.  And that is rewarding.

I'm grateful for all the advice and support I've received.  I'm grateful to have two talented staff members, Diane and Sylvia, who make my job easier.  And I'm grateful for the many loyal and terrific patients who've chosen to follow me in my new adventure.

I'm inviting patients, friends, family, friends of patient, and anyone curious to come see my practice.  Come to my open house on Thursday, January 25, 5:30-7:30 pm.  I'm proud of what I've created and I welcome you to take a look yourself.

Meet my office staff!

The office opened this week, and we are up and running seeing patients!!!

Let me introduce you to my staff members:

Diane Shockcor - Medical Assistant

Diane worked with me at Lakeside for over three years, and I can't be happier to have her join me at my new practice.  She's smart, works hard, and gets along well with patients.  Diane is a dog lover and has a boxer named Harley.  Her major flaw is that she is a Buckeye fan.

Sylvia Tadeo - Front Office 

Sylvia has over ten years of experience in the medical field, including as a medical assistant and a phlebotomist.  I met Sylvia a couple years ago at Tru Fit Bootcamp, where I was impressed by her dedication and the fact that she can do burpees far faster than I can.  Sylvia is also fluent in Spanish.

Call us for an appointment at 818-938-9505.  Or, come to our OPEN HOUSE on January 25, to say hi and see the new office!